Diagnosis and Treatment
The diagnosis must be initiated immediately on noticing any suspicious lumps or nodules in the breast. Initially, the symptoms, social habits, medical history, menstrual and reproductive history and family history of the patient are reviewed. A physical examination is done to identify lumps and observe any changes in the breast’s size, shape, and colour.
To confirm the diagnosis, the patient is recommended to undergo the following tests:
Imaging tests: These help to identify the stage and extent of breast cancer, and may include the following:
Biopsy: During biopsy, a small sample of breast tissue is collected and examined in the laboratory to determine any abnormalities. Fine-needle aspiration, core biopsy, and open biopsy are some types of biopsies based on the type of technique used to collect the tissue sample.
Cancer staging is performed using the TNM system to get a detailed information about:
The treatment aims to remove as much as cancer possible and to prevent the recurrence. Based on the type, size, and extent of cancer, the following treatment modalities are recommended:
Surgery is done to remove the tumour and some surrounding healthy tissue. It is usually recommended for early-stage breast cancers that are small in size.
External beam radiation therapy: It is the most common type of radiation therapy to treat breast cancer. In this therapy, high-powered radiation beams are delivered precisely on the affected area through a machine outside the body.
Brachytherapy: After surgical removal of the tumour, a device containing radioactive source is implanted temporarily into the breast tissue near the tumour site. This device emits high dose of radiation to the surrounding tissue, close to the original tumour, hence preventing the recurrence. However, based on the size, location, and other factors, the doctor may decide whether the patient requires brachytherapy or not.
Chemotherapy: It uses specific powerful drugs that interfere with the process of cell division and promote cancer cell death. Not all women with breast cancer require chemotherapy, however, it is recommended before the surgery to shrink a tumour or after the surgery/ radiation therapy to kill the remaining cancer cells, and in the advanced stage to control the spread. Chemotherapy can be given orally or through intravenous administration.
Hormone therapy: It is recommended in the treatment of breast cancers that are sensitive to hormones, such as estrogen or progesterone. Hormone therapy acts by either decreasing the production of hormones or blocking them from working. It can be given before or after the surgery to shrink a tumour and to lower the risk of recurrence.
Targeted Therapy: It uses specific drugs or substances that target specific characteristic of cancer cells. Targeted therapy is recommended in certain cases where breast cancer cells overexpress certain characteristic of proteins on the cancer cell surface, thereby promoting the abnormal growth pattern.
Immunotherapy: Immunotherapy involves the usage of certain medicines to boost a person’s immune system to find and destroy the cancer cells. Immunotherapies, such as atezolizumab and pembrolizumab are among the few FDA approved drugs for breast cancer treatment.